| NPI | 1518978063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA04703100) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA04703100) |
| 208600000X Surgery (Licence: NJ 25MA04703100) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2016-11-16 |